What is Arthroscopic Surgery?

The visit to the orthopaedic surgeon didn’t go as you
planned...surgery has been scheduled. The doctor explained that this is a simple
“scope procedure.” What does this mean?

The arthroscope is a small fiber optic camera inserted into
the joint to visualize and repair injuries. The surgeon will make two or three
small (about ˝ inch) incisions at the joint line of the knee to insert the
arthroscope and arthroscopic tools.

The camera contains an incredibly bright light source
to help
visualize the joint structures. The camera and arthroscopic instruments are
approximately 5 millimeters (˝ inch) in diameter. These small instruments are
used to repair the damaged structures.

A solution of sodium chloride flows into the joint,
facilitating the procedure. This solution serves two purposes. One, the constant
flow of the liquid will flush out any debris created by the procedure. Two, the
liquid distends the joint allowing the surgeon to see better. The camera acts as
a spigot, allowing the fluid to enter the joint. Suction, applied through other
instruments, removes the fluid.

Today the skilled orthopaedic surgeon uses the arthroscope to
assist with numerous injury repairs. The arthroscopic procedure has continued to
advance since its first use in the early 1970’s. Originally used as a
diagnostic tool to determine the extent of injury, the scope has evolved into
the preferred technique for many joint repairs. Advances in technology have
allowed the orthopaedic surgeon to become more innovative in the use of the
scope.

Advances in surgical techniques, combined with advances in
anesthesia, have resulted very short hospitalization after the procedure. Most
arthroscopic procedures are performed as day surgery. That is, the patient
reports to the hospital or out-patient surgical facility in the morning and is
home before the end of the business day. Many arthroscopic procedures can be
completed in under one hour. This results in a total hospital stay of 3 to 5
hours.

Repair of damaged structures is made easier due to the
magnification caused by the camera. Structures that are small to the naked eye
are made larger facilitating repairs. This picture
is a normal appearing ACL. This picture next to it is a torn ACL as seen on
arthroscopic evaluation. Notice the rope-like structure that is absent in the
middle of this picture.

Due to the small size of joints the instruments used are also
small. The magnification of the image by the camera makes use of these small
tools easier. The surgeon will use small probes to maneuver under the cartilage
to look for tears. Small scissors can be utilized to trim out torn tissue. The
tools of the orthopaedic surgeon are not unlike the tools of a master carpenter,
only on a much smaller scale. This picture shows the use of
an awl to “pick” the bone. This instrument is used in cases of premature
arthritic changes to encourage new joint surface cartilage formation

The surgeon can also utilize powered instruments to assist in
the repairs. The most commonly used motorized tool is called a shaver; it looks like a hollow tube with rotating teeth. This instrument is used to
remove large amounts of damaged tissue and is connected to a suction device.
Removal of the excised tissue is a very important part of any arthroscopic
procedure.

The arthroscope can be used in nearly any joint. Arthroscopic
surgeries are very commonly used in the larger joints of the knee and shoulder.
The small instruments allow the surgeon to access relatively small joints such
as the elbow and ankle.

Recovery Time

The use of the scope in surgical procedures results in less
trauma to the body when compared to “open” procedures. This has allowed
athletes to return to participation faster.

Recovery tine after arthroscopic surgery varies based on the
work performed. “Simple” procedures such as cartilage resection (removal of
a torn cartilage) can have a recovery time of as little as two weeks. In
contrast, recovery time from more complex procedures such as an ACL
reconstruction can take 4 to 6 months.

Actual recovery time can vary from person to person. The
surgeon’s repair of the damaged tissue is only half of the recovery. The
athlete must rehabilitate the surgical limb to regain normal strength, balance,
and sport specific techniques. If the athlete approaches the rehabilitation with
a poor attitude the outcome will be poor.

In all orthopaedic injuries the recovery after the injury or
surgery is extremely important. If the athlete does not return to participation
at full strength, he/she is asking for further injury to occur.